Introduction

A recent analysis by a national health care consulting firm raises the possibility of large-scale patient care disruptions resulting from COVID-19. Theses disruptions could particularly impact patients taking infused and injectable drugs at a physician’s office, infusion center, or hospital outpatient department.¹

This paper will document how home infusion services are a dependable way to meet the clinical needs of selected patients, while helping them reduce their public exposure risk during the COVID-19 outbreak. Home infusion can enable patients to receive the critical therapies they need, without having to manage the travel and logistics risks and concerns associated with leaving home to visit a clinic or hospital.

COVID-19: A broad spectrum of risk

Most people experience only mild illness due to COVID-19.² However, the Centers for Disease Control (CDC) warns that for people who have a weakened immune system, (immunocompromised), it can lead to severe illness, including pneumonia and death.³

Older adults – and people of any age – who have serious underlying medical conditions may be immunocompromised and have a reduced ability to fight infectious diseases, including viruses like COVID-19.³

There are many conditions and treatments which can cause someone to have a weakened immune system. They may have a chronic condition that affects the immune system, or they may take certain medications that in addition to their clinical effect, also work to weaken a person’s immune response. Common examples include some cancer treatments, drugs taken after an organ transplant, and medications used for autoimmune conditions, such as rheumatoid arthritis.⁴

Patients are avoiding clinics and offices

Medical claims data for all patients gathered by the IQVIA Institute shows steep declines in clinic visits (>50% lower) and physician office visits (~60% lower) in the immediate wake of the COVID-19 outbreak. While that trend has recently stabilized, it remains far lower than the original baseline.⁵

Now looking just at patients who rely on provider-administered drugs, early claims data following the COVID-19 outbreak shows a reduction in physician office visits, driving a decrease in provider-administered drug utilization.¹

One typical autoimmune disorder is rheumatoid arthritis (RA), a chronic inflammatory disorder that can affect the joints, plus a wide variety of other systems, including the skin, eyes, lungs, heart and blood vessels.⁵ In the graph below we can see the impact of COVID-19 on face-to-face visits for RA.

The orange line represents the decline in visits performed in an outpatient office setting. The blue line shows the decline in work performed by hospitals, skilled nursing facilities, and other institutions, both outpatient and inpatient. We see significant disruptions in patient access – up to 80% lower for institutions, and almost 40% lower for office visits:

Change from baseline in RA visits

While it is common for autoimmune patients to switch between medications, including between pharmacy- and physician-administered drugs, over the course of their treatment, this reduction in physician office visits is driving a decrease in provider-administered drug utilization – at least in the short term.¹

The consultant study points out that patients who typically visit a clinical site to receive treatment for autoimmune disorders now face a difficult choice: do they risk going out in public, knowing that their weakened immune systems put them at risk to a fast-spreading pandemic? Or do they stay home and go without their medication?¹

The home infusion option

One solution may be home infusion therapy. Infusion therapy is when a medication is administered directly into a patient’s vein. For some medications, infusion is the only suitable route of administration.⁷

Home infusion may not be right for every patient. But some patients, depending on their specific situations, do have the option to receive infused medications in their own homes. Even before the COVID-19 crisis, given the option, third party studies found that patients overwhelmingly preferred home infusion. They report significantly better physical and mental well-being, plus less disruption in their family and personal lives.⁸ These findings track closely with our own internal satisfaction surveys.

Home infusion services are a dependable way to reduce public exposure risk during the COVID-19 outbreak. Patients can receive the critical therapies they need, without having to manage the travel and logistics concerns associated with leaving home to visit a clinic or hospital.¹ A 2017 literature review found that, “Home infusion care can provide safe, clinically effective care, improve patients’ quality of life, and reduce healthcare costs.”⁸

Optum Infusion Pharmacy is working to help manage the significant health risk from COVID-19 for those who have traditionally received infusion services in the hospital or other clinic settings. For these patients, we’re providing infusion services in their homes through our nurse infusion specialists.

Optum home infusion services ensure access to critical infusion therapies for at-risk patients and is consistent with ‘stay at home’ and ‘social distancing’ guidelines from municipalities and health experts. For example, previously we mentioned the autoimmune disorder, rheumatoid arthritis. Remicade^® (infliximab) is an infused medicine used to treat rheumatoid arthritis and is one of the treatments available through Optum home infusion.

We understand that some patients – especially those who are most vulnerable – may have additional safety concerns during this difficult time. We have heard that some patients are concerned about letting anyone in their home and potentially exposing themselves, or the rest of their family.

This is why we have implemented enhanced precautions, based on guidance and resources from the CDC. For example, Optum infusion nurses begin every visit equipped with the personal protective equipment and disinfecting supplies recommended by the CDC when caring for patients suspected of, or diagnosed with, COVID-19.

These procedures, and others, are designed to help reduce the risk of asymptomatic exposure, and promote the safety of the patient and nurse.

Home infusion services require close coordination between the Optum Infusion pharmacist and the referring physician to develop a treatment plan, facilitate nursing services, and initiate home care. As a result, studies indicate that home infusion patients are no more likely to experience adverse drug events or side effects, and their clinical outcomes are as good as or better than in institutional settings. To learn more about the home infusion option, contact your consultant, broker, or OptumRx representative.

References

1. Avalere. COVID-19 Complicates Access to Provider-Administered Autoimmune Treatments. Published April 16, 2020.

2. Centers for Disease Control. Coronavirus Disease 2019 (COVID-19): What to Do If You Are Sick. Page last reviewed May 2, 2020. Accessed on May 4, 2020.

3. Centers for Disease Control. Coronavirus Disease 2019 (COVID-19): Groups at Higher Risk for Severe Illness. Page last reviewed: April 17, 2020.

4. Cleveland Clinic. Infectious Disease FAQs: What You Should Know About COVID-19 and Chronic Medical Conditions. Updated April 4, 2020. Accessed on May 4, 2020.

5. IQVIA. Monitoring the Impact of COVID-19 on the Pharmaceutical Market. Published April 17, 2020. Data week ending April 3, 2020.

6. Mayo Clinic. Rheumatoid arthritis. Accessed on May 4, 2020.

7. The Medical Dictionary. Intravenous infusion. Accessed on May 5, 2020.

8. Healthcare. Home Infusion: Safe, Clinically Effective, Patient Preferred, and Cost Saving. Published March, 2017.